1. Date of download: 7/6/2016 Copyright © The American College of Cardiology. All rights reserved. From: Obstructive Sleep Apnea and Heart Failure: Pathophysiologic and Therapeutic Implications J Am Coll Cardiol. 2011;57(2):119-127. doi:10.1016/j.jacc.2010.08.627 Effects of OSA on the RV and LV During obstructive sleep apnea (OSA), negative intrathoracic pressure generated against the occluded upper airway (UA) increases left ventricular (LV) transmural pressure (intracardiac minus intrathoracic pressure) and LV afterload. It also increases venous return, augmenting right ventricular (RV) pre-load, whereas OSA-induced hypoxia causes PA vasoconstriction and pulmonary hypertension. These cause RV distension and leftward displacement of the interventricular septum during diastole, which impairs LV filling and diminishes LV pre-load and stroke volume. PA = pulmonary artery; + = positive intracardiac pressure; − = negative intrathoracic pressure. Figure Legend:

2. Date of download: 7/6/2016 Copyright © The American College of Cardiology. All rights reserved. From: Obstructive Sleep Apnea and Heart Failure: Pathophysiologic and Therapeutic Implications J Am Coll Cardiol. 2011;57(2):119-127. doi:10.1016/j.jacc.2010.08.627 Cardiovascular Autonomic Effects of OSA This diagram illustrates a number of mechanisms by which obstructive sleep apnea (OSA) augments sympathetic and diminishes parasympathetic activity. BP = blood pressure; CV = cardiovascular; HF = heart failure; HR = heart rate; HRV = heart rate variability; PNA = parasympathetic nervous system activity; SNA = sympathetic nervous system activity; SV = stroke volume. Figure Legend:

3. Date of download: 7/6/2016 Copyright © The American College of Cardiology. All rights reserved. From: Obstructive Sleep Apnea and Heart Failure: Pathophysiologic and Therapeutic Implications J Am Coll Cardiol. 2011;57(2):119-127. doi:10.1016/j.jacc.2010.08.627 The Prevalences of OSA Reported in 4 Studies The prevalences of OSA reported in 4 studies involving unselected patients with HF who underwent overnight polysomnography. Ferrier et al. (73) used an apnea-hypopnea index cutoff of ≥10 whereas the others used ≥15. Abbreviations as in Figure 2. Figure Legend:

4. Date of download: 7/6/2016 Copyright © The American College of Cardiology. All rights reserved. From: Obstructive Sleep Apnea and Heart Failure: Pathophysiologic and Therapeutic Implications J Am Coll Cardiol. 2011;57(2):119-127. doi:10.1016/j.jacc.2010.08.627 Multivariate Cox Proportional Hazards Survival Plots of M-NSA Versus Untreated OSA Multivariate Cox proportional hazards survival plots show worse survival of HF patients with untreated OSA (AHI ≥15) than in those with M-NSA (AHI <15) (hazard ratio: 2.81, p = 0.029), after adjusting for significant confounders (left ventricular ejection fraction, New York Heart Association functional class, and age). Reproduced, with permission, from Wang et al. (78). M-NSA = mild to no sleep apnea; other abbreviations as in Figures 2 and 3. Figure Legend: